What is Telehealth, and how are we as clinical professionals to use this lawfully in our practice? These questions have become more of a top of mind concern than probably ever in US history after the recent outbreak of the Coronavirus. Due to this outbreak, the government has seen that it is necessary to expand the use of Telehealth and their definition of what is deemed to be appropriate or lawful.
According to The Health Resources and Service Administration, Telehealth is defined as the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration. Technologies include video conferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications. In Layman’s terms, Telehealth involves the use of electronic devices and technologies including computers, laptops, and mobile devices for the purposes of communicating or counseling with clients.
Only One In Ten Use Telehealth
The use of Telehealth services by healthcare providers has been astoundingly low. In 2019 a study by J.D. Power suggests that only 10% of healthcare consumers have ever used Telehealth services. These statistics could be even lower for Americans who have used telemedicine for counseling and behavioral health concerns. Although many major medical providers have approved various forms of telemedicine, it remains a diamond in the rough for those who qualify and could potentially use these services.
How Do Client’s Feel About Telehealth?
The satisfactory ratings for Telehealth are quite astonishing. I’ll be honest, prior to my own experience with providing Telehealth and Online Counseling Services, I was quite skeptical. This type of sentiment seems to be the same when I speak with my clients and even fellow clinicians who have not used Telehealth technologies for counseling services. There seems to remain a perception that Telehealth services are subpar, unprofessional, or inefficient, but a study by J.D. Power indicates a different reality. The consumer satisfaction report for Telehealth services are high, amazingly high. Telehealth services have been reported to be quite a catch for many of its users.
According to JD Power, the overall customer satisfaction score for Telehealth services is 851 (on a 1,000-point scale) and is 900 or higher among 46% of Telehealth users. “ We are looking at Telehealth services similar to mobile banking and its early adoption rates,” said Greg Truex, Managing Director, Health Intelligence at J.D. Power.”
Why Don’t More Clients Use Telehealth?
The J.D. Power study indicates that some of the primary limitations for clients to receive Telehealth services has been the lack of availability, the lack of awareness of provider coverage, and availability, especially in rural areas. Insurance companies are now becoming increasingly progressive about making Telehealth services more available under their plans. Even Federal Agencies such as the Centers For Medicare and Medicaid Services which host Medicare has opened its policies to allow for mental health professionals to bill for Telehealth counseling services through Medicare. Providers could be more aggressive with making their customers aware of the availability of coverages for Telehealth, but I also think that mental health professionals can participate in promoting the awareness and availability of these services as well. This could even serve as a tool for marketing to increase client conversions.
How Do Therapists Use Telehealth
Most clinicians, at least at this point, would likely use Telehealth through video conferencing and even telephone communication. Currently, I am licensed to provide mental health services in the state of Alabama. Teletherapy has been approved for behavioral health providers such as Blue Cross Blue Shield of Alabama in certain localities. An attestation has been required prior to the implementation of services, but recently due to the Coronavirus outbreak, I recently received correspondence indicating temporary approvals for Telehealth therapy through the use of telephonic communication.
The required attestation for Telehealth is being temporarily suspended in Alabama. These types of provisions have been on the rise across the nation during this Covid-19 crisis, but prior to the coronavirus pandemic, these lines of counseling and therapy communication were restricted in many state licensing boards and by many insurance providers. Things have rapidly been changing in the world of telemedicine, and these changes will likely become a more normalized mechanism of providing counseling and mental health services in the United States.
HIPPA Requirements for Telehealth Therapy Services
Prior to Covid-19, business associates agreements (BAAs) have generally been a Health Insurance Portability and Accountability Act (HIPPA) requirement when partnering with Telehealth vendors such as doxy.me. Companies such as doxy.me offer a platform for a therapist to provide online therapy to clients. The BAA requirements have been temporarily relaxed due to the coronavirus pandemic.
According to healthitsecurity.com, a business associate agreement is when a HIPPA covered entity formulates a partnership with other organizations to ensure the security of their data assets. BAAs are used to ensure that third party Telehealth communications vendors protect or keep private the communications activities between the mental health clinician and the client.
The US Department of Health and Human Services (HHS) has stated that if a mental health clinician has the need to provide Telehealth counseling services through a provider who does not provide a BAA The Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS) indicated that “OCR will not impose penalties against covered health care providers for the lack of a BAA with video communication vendors or any other noncompliance with the HIPAA Rules that relate to the good faith provision of Telehealth services during the COVID-19 nationwide public health emergency.”
Has The Government Recommended Any Telehealth Vendors?
At this point, the government has not offered a list of vendors that they are endorsing or recommending that meet the Federal Government’s criteria. However, the government has listed a number of Telehealth Vendors who offer BAAs. The list includes the following:
- Skype for Business
- Zoom for Healthcare
- Google G Suite Hangouts Meet
How Do I Get Set Up For Telehealth Counseling?
Once you have chosen which Telehealth provider you want to use, the setup is generally quite simple. Many of the providers will offer a free Telehealth plan while requiring additional charges for increased Telehealth communications features. For instance, doxy.me, one of the more recognized providers, provides subscriptions for both paid and free services. I found the doxy.me platform to be one of the easier platforms to use without financial obligation. This platform is very user friendly. There is no registration for the client and very few questions are asked for the client to complete prior to beginning the session. Some of the platforms that are available may require additions steps for setup, such as app downloads, and request of personal information from the client. Most platforms don’t require much time to get set up to begin your sessions. In many cases, you will be set up for Telehealth counseling sessions within minutes. You may need to request a BAA from the provider independently.
How Much Does It Cost?
Subscription services for Telehealth providers are fairly reasonable and many times free. Platforms that have free subscriptions may require that you apply to their paid plans if a BAA is requested. There may also be additional costs if you are applying for services for your group practice. The cost of each platform may vary. Most of the basic plans that I have explored have ranged roughly between $30 to $50 dollars per month with no contract requirements.
Can Telehealth Counseling Be Provided Across State Lines?
When I started writing this blog I had intended to mention that in most cases a clinician is restricted from providing Telehealth counseling services outside of the state that they are licensed in. But this news cycle has really been moving fast due to Covid-19. A press release issued by CMS on March 17, 2020, stated, “Beginning on March 6, 2020, Medicare—administered by the Centers for Medicare & Medicaid Services (CMS)—will temporarily pay clinicians to provide Telehealth services for beneficiaries residing across the entire country…Medicare beneficiaries will be able to receive various services through Telehealth including common office visits, mental health counseling, and preventive health screenings.”
CMS supported providers (particularly Medicare) will likely be the only insurance institutions that this guidance applies too. Until we hear otherwise, states and most major medical insurance providers such as Blue Cross Blue Shield, Aetna, and Humana will continue to restrict clinicians from offering Telehealth therapy services in states that they are not licensed in.
Presently there’s a great deal of panic and confusion all over the world due to the coronavirus pandemic. Hopefully, the increased use of Telehealth will positively impact clients as well as clinicians concerning their awareness and use of these much needed mental health services.
As therapists, we seek to provide services that save lives and brighten our client’s perspectives for tomorrow. It is my hope that through the use of Telehealth Counseling you will be able to make the difference in someone’s life today.
Choya Wise, LICSW, PIP is the owner of Aspire Counseling & Consulting Services in Huntsville, Alabama. Choya specializes in relationship counseling and hosts Online Social Work Clinical Supervision Groups in Alabama.